急性心肌梗死年轻患者事件前健康状况的性别差异：VIRGO研究分析

Gender differences in pre-event health status of young patients with acute myocardial infarction: A VIRGO study analysis.

作者信息

Dreyer Rachel P, Smolderen Kim G, Strait Kelly M, Beltrame John F, Lichtman Judith H, Lorenze Nancy P, D'Onofrio Gail, Bueno Héctor, Krumholz Harlan M, Spertus John A

机构信息

Center for Outcomes Research and Evaluation (CORE), Yale-New Haven Hospital, USA Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, USA

University of Missouri - Kansas City, School of Medicine, Biomedical & Health Informatics, USA Saint Luke's Mid America Heart Institute, USA.

出版信息

Eur Heart J Acute Cardiovasc Care. 2016 Feb;5(1):43-54. doi: 10.1177/2048872615568967. Epub 2015 Feb 13.

DOI:10.1177/2048872615568967

PMID:25681487

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4658311/

Abstract

AIMS

We assessed gender differences in pre-event health status (symptoms, functioning, quality of life) in young patients with acute myocardial infarction and whether or not this association persists following sequential adjustment for important covariates. We also evaluated the interaction between gender and prior coronary artery disease, given that aggressive symptom control is a cornerstone of care in those with known coronary disease.

METHODS AND RESULTS

A total of 3501 acute myocardial infarction patients (2349 women) aged 18-55 years were enrolled from 103 US/24 Spanish hospitals (2008-2012). Clinical/health status information was obtained by medical record abstraction and patient interviews. Pre-event health status was measured by generic (Short Form-12, EuroQoL) and disease-specific (Seattle Angina Questionnaire) measures. T-test/chi-square and multivariable linear/logistic regression analysis was utilized, sequentially adjusting for covariates. Women had more co-morbidities and significantly lower generic mean health scores than men (Short Form-12 physical health = 43 ± 12 vs. 46 ± 11 and mental health = 44 ± 13 vs. 48 ± 11); EuroQoL utility index = 0.7 ± 0.2 vs. 0.8 ± 0.2 and visual analog scale = 63 ± 22 vs. 67 ± 20, P < 0.0001 for all. Their disease-specific health status was also worse, with more angina (Seattle Angina Questionnaire angina frequency = 83 ± 22 vs. 87 ± 18), worse physical function (physical limitation = 78 ± 27 vs. 87 ± 21) and poorer quality of life (55 ± 25 vs. 60 ± 22, P<0.0001 for all). In multivariable analysis, the association between female gender and worse generic physical/mental health persisted, as well as worse disease-specific physical limitation and quality of life. The interaction between gender and prior coronary artery disease was not significant in any of the health status outcomes.

CONCLUSION

Young women have worse pre-event health status as compared with men, regardless of their coronary artery disease history. While future studies of gender differences should adjust for baseline health status, an opportunity may exist to better address the pre-event health status of women at risk for acute myocardial infarction.

摘要

目的

我们评估了年轻急性心肌梗死患者事件前健康状况（症状、功能、生活质量）的性别差异，以及在对重要协变量进行序贯调整后这种关联是否仍然存在。鉴于积极控制症状是已知冠心病患者治疗的基石，我们还评估了性别与既往冠心病之间的相互作用。

方法与结果

从美国103家/西班牙24家医院（2008 - 2012年）招募了3501例年龄在18 - 55岁的急性心肌梗死患者（2349例女性）。通过病历摘要和患者访谈获取临床/健康状况信息。事件前健康状况通过通用量表（简明健康调查简表12、欧洲五维度健康量表）和疾病特异性量表（西雅图心绞痛问卷）进行测量。采用t检验/卡方检验和多变量线性/逻辑回归分析，并对协变量进行序贯调整。女性合并症更多，通用平均健康评分显著低于男性（简明健康调查简表12身体维度 = 43 ± 12 vs. 46 ± 11，精神维度 = 44 ± 13 vs. 48 ± 11）；欧洲五维度健康量表效用指数 = 0.7 ± 0.2 vs. 0.8 ± 0.2，视觉模拟量表 = 63 ± 22 vs. 67 ± 20，所有比较P < 0.0001。她们的疾病特异性健康状况也更差，心绞痛更多（西雅图心绞痛问卷心绞痛发作频率 = 83 ± 22 vs. 87 ± 18），身体功能更差（身体限制 = 78 ± 27 vs. 87 ± 21），生活质量更差（55 ± 25 vs. 60 ± 22，所有比较P<0.0001）。在多变量分析中，女性性别与较差的通用身体/精神健康之间的关联仍然存在，疾病特异性身体限制和生活质量较差的情况也仍然存在。性别与既往冠心病之间的相互作用在任何健康状况结果中均不显著。